From the Guidelines
The patient has clinical features of pelvic floor dysfunction due to the presence of an incidental large anterior rectocele. The large subserosal fibroid (12.2 x 20.3 x 16.6 cm) extending above the umbilicus is unlikely to directly cause pelvic floor dysfunction, but its significant size and weight could potentially exacerbate symptoms by increasing intra-abdominal pressure 1. Management should include assessment for symptoms such as:
- difficulty with defecation
- sensation of incomplete emptying
- digital assistance needed for bowel movements
- urinary incontinence
- or pelvic pressure. If symptomatic, conservative approaches include:
- pelvic floor physical therapy
- pessary use
- and lifestyle modifications (fiber supplementation, adequate hydration, weight management) 1. Surgical repair may be considered for symptomatic rectoceles that fail conservative management, but should be addressed separately from the fibroid management 1. The presence of both conditions requires comprehensive evaluation to determine appropriate treatment priorities based on symptom severity, as the correlation between symptoms and rectocele size is weak, and the correlation between improvement in symptoms and anatomy after surgical procedures is also weak 1. The most recent guidelines from 2024 support a comprehensive approach to managing uterine fibroids and pelvic floor dysfunction, emphasizing the importance of individualized treatment plans based on symptom severity and patient preferences 1.
From the Research
Clinical Features of Pelvic Floor Dysfunction
The patient's condition, including an anterior FIGO 6 subserosal fibroid and a large anterior rectocele, may be associated with clinical features of pelvic floor dysfunction.
- Pelvic floor dysfunction (PFD) is related to a variety of pelvic pain syndromes and organ problems of continence and evacuation, as noted in 2.
- The presence of a rectocele, in particular, can cause symptoms such as pelvic pain, pressure, or difficulty with passing stool, as well as other associated pelvic floor disorders, according to 3.
- Pelvic floor disorders, including rectoceles and pelvic organ prolapse, can cause distress and difficulty with daily functions and self-image, and may present with a wide spectrum of symptoms and anatomic defects, as discussed in 4 and 5.
Evaluation and Diagnosis
A thorough history and physical examination are essential for evaluating patients with suspected pelvic floor dysfunction, as emphasized in 6 and 5.
- The clinical evaluation should aim to identify the specific symptoms and anatomic defects present, as well as any associated conditions, such as urinary incontinence, anal incontinence, or sexual dysfunction, as noted in 4 and 5.
- A comprehensive approach to diagnosis and treatment is necessary to provide effective management of the patient's symptoms and improve quality of life, as discussed in 2 and 5.